It’s well-known that obesity can be linked to high blood pressure, diabetes, heart disease, and ultimately to death. But now a new Dutch study is linking severe obesity to cardiovascular risk factors even among kids as young as 2 years old.

The nationwide study in the Netherlands found that two-thirds (67%) of severely obese kids already have at least one heart disease risk factor: high blood pressure, high LDL (“bad”) cholesterol, low HDL (“good”) cholesterol, or high total cholesterol, high triglycerides, high fasting blood glucose or Type 2 diabetes.

The data come from doctors’ clinical records across the country. From July 2005 to July 2007, every pediatrician working in a general hospital in the Netherlands was asked to report all new cases of severe obesity among children aged 2 to 18 (with the definition of “severe obesity” varying by age and gender). Then, a group known as the Dutch Pediatric Surveillance Unit tabulated the numbers and asked the pediatricians to report each case’s age, sex, ethnicity and family circumstances, as well as measurements of blood pressure, fasting blood glucose, cholesterol and triglycerides. In total, 500 cases of severe childhood obesity were reported.

Of course, in the U.S. too, there are signs of early heart-disease development among overweight young people. A recent study from the Centers for Disease Control and Prevention found that, just as in the Netherlands, roughly two-thirds of obese U.S. teens have at least one cardiovascular risk factor. More alarmingly, that study found that among all U.S. teens, even those who are not currently overweight, roughly one quarter have diabetes or pre-diabetes.

What’s most remarkable about the new Dutch study, however, is that it finds signs of heart disease even among much younger children still. Among the severely obese Dutch boys and girls aged 2 to 12, 62% showed one or more risk factors. Roughly half of those youngsters were hypertensive.

Writing in the medical journal Archives of Disease in Childhood, the Dutch researchers note that out of the hundreds of children diagnosed as severely obese, “Only one child was obese because of a medical cause,” a hypothalamic tumor. The rest, it seems, were obese instead due to unhealthy lifestyle — a risk factor that continues to spread across the globe.